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Biomedical subjects

J C Letard

Publications and source records attributed to J C Letard.

16 recordsLinked to original sources
PubMed2000

Intraoperative endoscopic sphincterotomy is a reasonable option for complete single-stage minimally invasive biliary stones treatment: short-term experience with 57 patients.

BACKGROUND AND STUDY AIMS: How to approach common bile-duct (CBD) stones discovered during laparoscopic cholecystectomy (LC) is still a subject for debate. After sequential strategies, the natural trend is now towards single-stage therapy. The aim of this study was to establish the feasibility of intraoperative endoscopic sphincterotomy (IOES) when CBD stones are discovered or strongly suspected on intraoperative cholangiography (IOC) during LC. PATIENTS AND METHODS: Out of a total of 2193 laparoscopic cholecystectomies, we reviewed 57 patients who, between 1991 and 1999, underwent IOES just after LC during the same anesthetic session. Under fluoroscopic guidance, one group of 32 patients (Dijon) underwent IOES in the prone position and a second group of 25 patients (Poitiers) in the left lateral position. RESULTS: IOES was successful in all cases (100%). CBD stones were definitively found in 49 cases (86%) but retrieved or released into the duodenum after IOES in only 46 cases (46/49, 93.9%). The mean duration of the intraoperative endoscopic procedure was 28 minutes (range 15-75). The short-term complication rate was 7%. The mean postoperative hospital stay was 5.3 days (range 2-14). CONCLUSIONS: IOES performed after LC during the same anesthetic session is feasible with low risk and with good results. It offers the opportunity to treat in one stage both cholecystolithiasis and choledocholithiasis without the need for surgical CBD exploration.

Adolescent↗
PubMed1997

Recurrence of biliary drug lithiasis due to dipyridamole.

The occurrence of drug-containing gallstones is not often observed. To our knowledge, three drugs have so far been incriminated-ceftriaxone, glaphenine, and dipyridamole. This report presents the case of an 85-year-old woman who developed a recurrent drug-containing gallstone caused by dipyridamole eighteen months after a previous stone had been removed endoscopically.

Aged↗
PubMed1994

[Ultrasonographic aspect of the rectal wall in liver cirrhosis].

The aim of this study was to assess the ultrasonographic abnormalities of the rectal wall and surrounding structures in patients with cirrhosis and to correlate these findings with endoscopy. From November 1992 to May 1993, 53 cirrhotic patients and 30 control subjects were examined by transrectal ultrasonography and rectoscopy. In addition to rectoscopy and transrectal ultrasonography, patients with cirrhosis underwent an upper gastrointestinal endoscopy. Ultrasonography abnormalities of the rectum were detected in 32 cases of cirrhosis (60.5%): a) in 21 cases the rectal wall thickness was greater than 5 mm and the sub-mucosa was thickened ( > or = 2 mm) and dissected by thin echo-free elements; b) the remaining 11 patients presented, in addition to the previously described abnormalities, rounded elongated echo-free structures surrounding the rectum which were not found in the control group. All these 11 patients had rectal varices at rectoscopy. In the group of cirrhotic patients, rectoscopy showed abnormal dilated veins in 23 cases (43.5%) and rectal varices in 11 cases. Ultrasonographic and endoscopic abnormalities of the rectum were more often visualized in the group of cirrhotic patients than in the control group (P < 0.001). In patients with cirrhosis, the demonstration of rectal varices was associated with transrectal ultrasound abnormalities (P < 0.01), and in particular peri-rectal vascular formations. In cases of cirrhosis the rectal wall abnormalities were not associated with gastric varices at endoscopic inspection but were linked with large esophageal varices or gastric mucosal abnormalities demonstrated on endoscopy (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopy, Gastrointestinal↗
PubMed1993

Endoscopic ultrasonography classification of gastric varices in patients with cirrhosis. Comparison with endoscopic findings.

Endoscopic ultrasonography was performed in 80 cirrhotic patients and 50 control subjects. The aim of the study was to describe and classify the vascular abnormalities of the gastric wall as observed on echoendoscopy in cirrhotic patients and to compare the data with endoscopy. The size of gastric varices was classified into 3 grades: grade 0 (none), grade 1 (small or non-confluent varices < 5 mm), grade 2 (large or confluent varices > or = 5 mm). The abnormalities of the gastric wall were classified into 3 grades: 0 (none), grade 1 (thickening and brilliance of the third hyperechogenic layer with or without fine internal anechogenic structures), grade 2 (visible vessels in the third layer which deform the entire wall, with penetrating varices). Endoscopy provides better visualization of esophageal varices than echoendoscopy but does not detect gastric varices and the first signs of portal hypertension as well. In conclusion echoendoscopy should be a routine examination for screening portal hypertension in cirrhotic patients and could be used in therapeutic follow-up.

Digestive System↗
PubMed1993

[Reversal of portal blood flow in cirrhosis. Clinical, endoscopic and ultrasound endoscopic correlations in 72 patients].

From January to December 1991, the portal venous system was evaluated by Doppler ultrasonography in 72 patients with liver cirrhosis. The objectives of this study were to evaluate the prevalence of spontaneous reversal of blood flow in the portal vein and to assess the relationship between Doppler ultrasound investigation and clinical, biochemical, endoscopic (70 patients), and endosonographic (44 patients) features. Reversed flow was quite frequent (alternating: 17%, permanent: 22%) and its prevalence did not differ in relation to age, sex, serum gammaglobulin concentration and Child-Pugh class. In patients with reversed portal venous flow, the prevalence of hepatic encephalopathy was higher (39% vs 13.5%, P < 0.05), but the prevalence of esophageal or gastric varices was not related to that pattern. Endosonography detected gastric wall abnormalities in a higher proportion of patients with reversed portal flow than in patients without it (P < 0.05). This study suggests that reversal of flow in the portal vein could play a role in the development of the gastric wall abnormalities in liver cirrhosis, which are detected by endosonography but not by endoscopy.

Adult↗
PubMed1992

[Esophageal candidiasis in HIV positive patients. Lack of statistical correlation with CD4 lymphocytes].

One hundred and twenty-nine upper gastrointestinal endoscopies were performed between November, 1986, and November, 1990, at the Fort-de-France Hospital (Martinique), on 92 patients who were seropositive for the human immunodeficiency virus (HIV). Blood samples were drawn at the same time as 75 endoscopic examinations and the number of CD4 lymphocytes/mm3 was determined. The incidence of esophageal candidiasis was 23.1% and lesions were observed in 17.2% of the endoscopies performed systematically at the time that the patient's seropositivity was first established. No significant relationship was found between the presence of esophageal candidiasis and peripheral blood CD4 lymphocyte counts.

AIDS-Related Opportunistic Infections↗
PubMed1990

[Alithiasic cholecystitis and viral hepatitis B disclosing periarteritis nodosa].

The authors report the case of a patient with acute alithiasic cholecystitis associated with viral B hepatitis revealing periarteritis nodosa. Histopathological results showed signs of focal arteritis in the gallbladder and liver. Because of the negativity of the viral DNA in serum and the lack of histopathological necrosis in hepatic specimen, the patient was treated by steroid therapy only with a rapid regression of signs of vasculitis and the disappearance of the hepatitis markers.

Adult↗
PubMed1990

[Report of a case of post-radiation hepatopathy].

We report the case of a 65 year-old woman treated by radiation therapy alone for Hodgkin's disease. She developed febricule, nonicteric cholestasis, and inflammatory syndrome two months after irradiation. The clinical record, biological and histological results allowed us to dismiss another etiology especially an hepatic location of Hodgkin's disease. Out come after a twenty months predominance of pathohistological abnormalities in the centrilobular region were in favor of a radiation-induced hepatitis.

Aged↗